Diseases of the vascular vessels are among the most frequent diseases with fatal outcomes. In particular these include coronary infarction caused by diseases of the coronary vessels. If arteriosclerotic plaque causes an occlusion of coronary vessels, these symptoms are generally treated using Percutaneous Transluminal Coronary Angioplasty (PCTA). The constricted points of the coronary vessels are expanded in such cases with a balloon catheter. However clinical studies have shown that with very many patients a restenosis occurs, in some cases these types of restenosis have occurred in 50% of the patients. High-frequency rotablation angioplasty has been known as an alternative method for a number of years, which can be used advantageously, especially for fibrotic or calcified or extensive stenoses.
To reduce the danger of the formation of restenoses, coronary rotablation is used in order to achieve a recanalization of stenosized coronary arteries through “debulking”. Conventional rotablation catheters consist of a diamond-tipped olive-shaped drill head which is rotated at very high speed and selectively grinds away and removes calcified and fibrotic plaque, while the stochastic vessel wall is pushed away from the drill head and accordingly not damaged. This method has become known as “differential cutting”. The microparticles removed are flushed away into the periphery. Such a rotablation catheter is now seen as a valuable instrument for serious vertical lesions which cannot be removed by simple balloon angioplasty. By contrast with balloon angioplasty the restenosis is not widened. At a typical speed of rotation of 150,000 rpm the ground-off microparticles are so small that they are filtered by organs such as liver, lungs and spleen without causing damage in the body.
A device for transluminal microdissection is known from EP 0 229 620 B1. This document describes a rotablation catheter consisting of a drilling head with a diameter of around 1 to 3 mm, which is connected via a highly-flexible shaft to a pneumatically-driven turbine. The turbine is driven by compressed air and controlled from an operating device. The flexible drive shaft consists of a drive cable and is surrounded by a shell through which a flushing fluid is supplied under pressure. The flushing fluid prevents the drive cable heating up and washes out the microparticles to distal locations. This therapy is conducted under x-ray control after provision of contrast means with an angiography device. The disadvantage is however that the parts of the body to be examined, such as coronary vessels, are only shown in two dimensions as a silhouette. Thus no information can be provided about the structure of the deposit, its thickness or inflammatory processes. The medical personnel can barely distinguish between plaque and vessel wall during the intervention, since assessing the severity of the calcification and especially the position of the calcium in the plaque is difficult on the basis of the angiographic image. Accordingly the risk arises of either too little plaque being removed and the desired blood flow not being re-established, or that the risk of a restenosis remains, in extreme cases too much tissue can be removed, resulting in a perforation of the vessel.
In DE 10 2004 008 368 A1 a rotablation catheter with an IVUS sensor for use in blood vessels has been proposed. The image display in the remote area of the restenosis is improved with this catheter.
In DE 10 2004 008 370 A1 a rotablation catheter with an integrated OCT sensor for use in blood vessels has been proposed, through which the image display in the local area of the restenosis is improved.
A medical examination and treatment system has been proposed by US 2005/0101859 A1 which combines the OCT and IVUS imaging methods in one device. This enables overlaid 2D image recordings to be created, with the OCT image element being used for the local area and the IVUS image element for the remote area.
A medical examination and/or treatment system is known from US 2005/0113685 A1, in which the imaging methods OCT and IVUS are combined in one catheter, which is also provided with a position sensor. 3D images can be created by means of the information recorded by the position sensor.
The factor common to all known solutions however is that they only resolve individual problems in each case, it has not however been possible thus far to integrate the conventional catheter in an optimum way into the medical workflow.